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The Modern Psychiatric In-Patient Technician: Skilled Worker or Guard?

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One of my earliest memories as an adolescent in an in-patient unit was the tall, stocky men brazenly hanging around the treatment areas, lounge, and nurse’s station.

These people were anomalous.

They didn’t seem to have a purpose at first glance.


I couldn’t have been more wrong about that! A few days into my hospitalization, a buzzer went off while I was in a group. All of a sudden, I was transported back to Nazi Germany. All I heard was loud shouting and a frenzy of hand gestures:

” Go to your room!” at which point, a buzzer went off, and the loudspeaker called a code on my unit.

In my room, I heard: “Just relax, and this will go a lot easier…”.

I listened to a girl screaming louder and louder until the voice eventually subdued, submitted to the modern psychiatric technician’s will.

Some days, however, there really didn’t seem to be a point for this group of staff to be present. During “Quiet Time,” these technicians would put up their hands and redirect us to our rooms. At other times, they watched us play outside if we were allowed out in the courtyard. These weren’t clinicians, indeed not peers, and yet, we were surrounded by them. They comprised the bulk of the unit’s staff around the hospital.

Most of the time, it is unfriendly, sometimes empathetic, but never an equal or someone to speak to when feeling the need for the confide or opening up to staff. While I never feared technicians, I certainly was very suspicious of them long before any paranoia was an issue.

There was something very wrong with this picture. Why was the largest pool of staff members, these technicians the least trained and the least educated out of all the hospital staff? Most of the technicians were out of high school or working part-time without a higher degree. This wouldn’t be an issue if these workers weren’t charged with our safety and welfare. In the event of a unit emergency and staff needed to protect a patient from another patient, the technician makes the judgment call to proceed with restraints.

Maybe my issue was that I was in a space where I was vulnerable and needed to be protected potentially from my peers. So, given the technician’s primary responsibility is safety, why call them technicians and not guards. Weren’t we in need of security and protection in the event of a psychiatric crisis?

In the movie One Flew Over the Cuckoos Nest, this wasn’t the case. In the movie’s final scene, Randal McMurphy chokes evil nurse Ratchet after her last act of psychological terrorism on the unit and a fellow patient’s death. In this scene, before Nurse Ratchet loses consciousness, Randal is tackled by technicians or guards.

Perhaps it is because I knew, if I were ever to lose behavioral control, I would be at this disposal and will of these poorly trained and quick-tempered workers. The thought is frightening. Even more alarming are the allegations of abuse aimed at these workers in state hospitals and local psychiatric units in your local backyard. It happens. It happens all the time. So, what can be done? How are hospitals completely re-organize not only their staffing but their emergency protocols?

Well, these measures are already being considered, thank heavens. The use of force is being recalled and re-evaluated by many professionals in the field. I hope that these revisions occur before too many more incidents and abuse cases emerge on the national headlines and spotlight. My suggestion is to get to know your technicians, be friendly, and open to their quasi treatment recommendations and soft Psychology.

In some cases, they are included in treatment team meetings, so smile and put a happy face on even when you know their suggestions are often inaccurate and without scientific value. If you are lucky enough to get out of the hospital unscathed, you did that much better than Randal.

About the Author

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association.

Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia.

"I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others."

"In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."

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